Coronary Artery Bypass Grafting of Chronically Occluded Right Coronary Artery Improves Long-Term Survival

Objectives: The benefit of revascularizing chronically occluded coronary arteries remains debatable and available long-term outcome reports are sparse. Current guidelines recommend revascularization of chronically occluded arteries only in patients with myocardial ischemia and/or symptoms associated with angina. We investigated outcome of patients with total chronic occlusion of the right coronary artery (RCA) receiving CABG surgery with and without revascularization of the RCA.

Methods: We retrospectively analyzed all patients with chronically occluded right coronary arteries receiving CABG with (Group 1 = RCA-CABG; n = 487) and without (Group 2 = no RCA-CABG; n = 100) revascularization of the RCA. 587 patients with complete follow-up of a minimum of 6 years were included (92%).

Result: 82% in Group 1 versus 86% in Group 2 were male (p = 0.38). EuroSCORE II was comparable between both groups (4.35 ± 7.09% vs. 4.80 ± 5.77%, p = 0.56) with no major differences regarding preoperative characteristics between groups.

Patients in Group 1 received 3.24 ± 0.79 distal anastomoses, whereas Group 2 received 2.45 ± 0.83 distal anastomoses (p < 0.001). While In-hospital mortality was comparable (2.9% in Group 1 vs. 5.0% in Group 2, p = 0.27), long-term survival after surgery was significantly better in Group 1 (p = 0.002). No difference in the incidence of further major adverse cardiac and cerebrovascular events (MACCE) was found.

Conclusion: Patients with a chronically occluded right coronary artery undergoing CABG who did not receive a RCA-graft showed a significantly reduced long-term survival. Given the here presented data, revascularization of chronically occluded right arteries during CABG should be recommended whenever technically feasible.

Publication History

Article published online:
19 February 2021